Provider Demographics
NPI:1346556602
Name:RIDDELL, CHRISTIANNA (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTIANNA
Middle Name:
Last Name:RIDDELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S FULTON ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-3612
Mailing Address - Country:US
Mailing Address - Phone:479-746-4260
Mailing Address - Fax:479-754-4060
Practice Address - Street 1:112 S FULTON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3612
Practice Address - Country:US
Practice Address - Phone:479-746-4260
Practice Address - Fax:479-754-4060
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2452225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant